Methylenedioxypyrovaleronee

Pennsylvania State Police and the Bradford County Coroner's Office are investigating three drug related deaths that happened in the last three days. Authorities believe the anesthesia prescription drug, fetanyl, is being added into a batch of heroin that's causing the fatal overdoses.

1. On the 21st of October 1995, Anna Wood took an ecstasy tablet at a dance party and died three days later. At such a young and thriving age, Anna Wood was just 15 years old with a loving family, many friends and a new job. On the night of the event that had taken place a series of risk behaviours were undertaken. Firstly by wanting to take an ecstasy tablet to get high as well as not having any knowledge on the actual drug. By having a broader knowledge on the drug she may have been still alive as she would’ve only had taken half due to knowing a whole tablet would be too much.

When you think of the word "drug" what comes to mind? Probably marijuana, cocaine, lsd, prescriptions but what about bath salts? When I first heard stories about people on bath salts my reaction was you have to be kidding right, but no first popping onto the radar of the DEA and poison control in 2010, this product is causing quite a stir in the United States. Mark Ryan from the LA poison control says in an interview on the Dr. Oz television show "that he has never seen a drug that has caused the problem as quickly and severely as this". Making local and national headlines as the new designer drug that is completely legal, for now at least, and very dangerous. It doesn't stop people from purchasing it and snorting, ingesting, injecting

"The toxicology studies on blood reveal the presence alprazolam, and amphetamine at levels likely consistent with the therapeutic range, a metabolite of buproprion and a high level of fentanyl. Phenylpropranolamine and amphetamine are present in the urine. When fentanyl and alprazolam are taken together there may be a synergistic central nervous system depressive effect. Based on the history and circumstances, s currently known, the manner of death is accident."

The British doctor, Dr. Harold “Dr. Death” Shipman was a silent killer. The law enforcement and attorneys must have evidence to convict any person in a court of law. Some of the key factors in this case appear to be circumstantial evidence and there was no forensic evidence presented. The first factor is that Harold Shipman was admitted for psychiatric treatment and a drug conviction in 1976 and the General Medical Council was aware of this serious issue. Yet, they allowed him to continue to practice without any documentation being filed, so they say, and no monitoring was implemented for Harold. Dr. Shipman established a pattern in which all of the victims were injected with morphine/heroin as a result of the coroner’s reporting.

There were a lot of crazy violent cases reported of people being on bath salts and going insane. Such as a man chewing on another man’s face then the cops having to shot him more than once because the first time that shot he turned around and growled at them some say the people on bath salt cannot feel any pain. There were cases reported of a woman dropping her toddler in the middle of the highway after she had crossed it and of kids taking their own lives.

Forensic toxicologists study the toxicity of fentanyl using different scientific methods. In a study done by the Journal of Medical Toxicology, the deceased bodies of 92 humans with one or more transdermal patches were examined to determine the concentration of fentanyl dosage involved in the cause of death. Additionally, testing is furthered using animals subjects

The news of Marilyn Monroe’s death began to spread. Newspapers were seen everywhere with her bright, smiling face and the giant, bolded letters of ‘death’ stamped on the front pages. Even The New York Times published a newspaper article titled “Marilyn Monroe Dead, Pills Near.” In this article, Dr. Theodore J. Curphey, the coroner, declares Monroe’s death to have not been from natural causes: “After an autopsy the Los Angeles coroner reported that Miss Monroe's ‘was not a natural death.’ He attributed it to a drug” (“Marilyn Monroe Dead, Pills Near”). Her death seemed to be the typical case of overdosing on barbiturates with traces of chloral hydrate which are both sedatives or sleeping pills (Los Angeles County Coroner’s Mortuary, 1962). There

Between June 1980 to March 1981 four babies died at Toronto Children's Hospital. In the cardiac ward 4A and 4B was where is was happening. They were suspicious at first but declared there wasn’t a problem. In January 1981 the first victim that stood out was four-month old Janice Estrella, her autopsy showed high Digoxin level. Digoxin is a controlled drug that increase circulation and slows heart rate. Next victim happened in March of 1981 his name was Kevin Pacsai only twenty-three days old even though his condition wasn’t even life threatening, however the nurse failed to convince the doctors to attend to Kevin Pacsi even though he was struggling the morning of his death. Kevin’s autopsy came back and showed high dosage of Digoxin. After Kevin Pacsai and Janice Estrella died the connor called the police he suspected that there is a killer. Allana Miller also died of Digoxin poison. After Allan miller died they locked up the Digoxin and be administered on emergency situations

Harold Shipman, during his adolescent years, is also interested in pursuing medicine as a career. Shipman’s high intelligence earns him a scholarship to Leeds School of Medicine. As with Holmes, everything is not exactly normal with Shipman during this time. After graduating from university, Shipman finds a job as a general practitioner and soon after finds himself addicted to drugs. This difficult time for Shipman is described in more detail as, “Shipman was convicted of making out drug prescriptions to himself and given a heavy fine. He was also fired from his job at the Todmorden practice” (Profile). This drug addiction is very possible it could stem from the childhood event of his mothers death and the up close exposure to morphine that his mother used. This is very similar to Holmes case, as Holmes disfiguring of corpses most likely stemmed from his exposure of a skeleton as a child. Another interesting detail about this event of his drug addiction is that the drug he abused was a morphine-like drug, which is important to know since his mother used morphine. It is evident he had a fascination with morphine considering it is also what he used to kill his victims, for example, “the jury found Shipman guilty of killing 15 patients by lethal injections of diamorphine” (Dr. Harold). This obsession with morphine can all stem back to his childhood exposure to the drug when he was first fascinated to the power of it able to bring his mom out of pain. After going through

Rates of opioid-related overdose have been rapidly increasing in the United States. From 2010-2015, overdose deaths attributed to the use of illicit opioids has increased by over 200% (1). In 2016, the number of opioid-related deaths reached 64,070, the highest number ever recorded in the nation’s history and anticipated to increase (2). While opioid-related overdose had been largely caused by prescription opioid misuse, the problem is increasingly due to heroin and other illicit opioid use (3, 4). Increasingly, illicitly-manufactured fentanyl (IMF), an opioid much stronger than heroin, has become an increasingly common additive pervasive in the supply in the United States and has contributed to the steep rise in opioid-related overdose (5-8).

Australian Crime Commission, 2013. Drug Analouges and Novel Substances, p, 2. Available from: < https://www.crimecommission.gov.au/sites/default/files/DRUG%20ANALOGUES%20AND%20NOVEL%20SUBSTANCES%20JULY%202013.pdf>. [25 May 2014]

While it was suspected that these deaths were suspiciously connected in some way, it was questionable as to how they were connected. However, it was noticed by two firefighters monitoring calls that both families had announced that the victims had ingested Tylenol prior to collapsing. The firefighters, Phillip Cappitelli and Richard Keyworth “call[ed] the coroner who confirms capsules of Tylenol obtained from both victim homes and finds 65 milligrams of cyanide in some of them” (Rowe.)

B’s tolerance to opiates not considered, Mr. B.’s clinical situation not considered (i.e., Mr. B’s age and renal function), and knowledge deficit of opiates. Drilling down the data to identify the root cause of Mr. B’s death is the fifth step in conducting a RCA on Mr. B’s sentinel event. Upon analyzing the data, causative factors, and events leading to Mr. B’s sentinel event, the RCA team determined that the root cause of Mr. B’s death is a medication error. Mr. B was given an overdose of hydromorphone. The final step in a root cause analysis is to implement changes that will mitigate the root cause. Changes include educating the nursing staff about hydromorphone, such as side effects and adverse reactions,

"Bath salts" is the common name for a group of drugs called synthetic cathinones. These are drugs made of chemicals from a plant (khat). They may be sold as pills, crystals, or a powder that is white, tan, or brown. There is no medical use for bath salts. They are designed to have the same effects as cocaine, ecstasy, and amphetamines without being illegal (designer drugs). They work by stimulating the release of a certain brain chemical (dopamine). A high level of dopamine in the brain can cause high blood pressure, rapid heartbeat, and seizures.